Early Initiation Of Cardiopulmonary Resuscitation Research Articles

Individual, environmental and demographic factors may play a role in the prognosis of fatal and non-fatal paediatric drowning.

Drowning is a leading cause of unintentional death. Ongoing efforts are dedicated to preventing these tragic incidents. Our aim was to evaluate whether demographic, environmental and epidemiological characteristics of drowned children influence their prognosis. Single-centre retrospective study spanning 12 years. Each patient's record included: age, sex, place of residence, presence of siblings, season of incident, location of event, associated trauma, loss of consciousness, need for cardiopulmonary resuscitation, intubation, admission to intensive care unit, length of stay and mortality. We enrolled 60 patients, with a mean age of 5.9 ± 3.4 years; 63.5% were male. Children who did not reside near the sea were significantly older than those who did (p = 0.01) and faced a higher risk of experiencing sea-related drowning (p = 0.05). No patients died. Loss of consciousness and need for cardiopulmonary resuscitation were recorded in 30 and 19 patients respectively. Seven patients sustained trauma. Only one patient requiring intubation. Pool-related drowning were associated with a higher incidence of needing cardiopulmonary resuscitation (p = 0.02). The need for cardiopulmonary resuscitation (p = 0.05) and the occurrence of trauma (p = 0.02) were identified as risk factors for a longer hospitalisation. Prevention and early initiation of cardiopulmonary resuscitation are essential for achieving a favourable prognosis. Identifying demographic and environmental risk factors may help identify other effective preventive measures.

Procedure and effectiveness of Basic Cardiopulmonary Resuscitation during the landing of an airplane: an exploratory study on military flights

"Introduction: The incidence of cardiorespiratory arrest (CRA) in aircraft is estimated at one per 5-10 million flights. The early initiation of cardiopulmonary resuscitation (CPR) can double or quadruple survival rates after CRA, and is associated with a better prognosis in terms of decreased brain damage and better quality of life. The aim of the present study is to evaluate the effectiveness of basic CPR procedures carried out by the flight crew in a clinical simulation performed in a real environment, during the landing of a military training flight. Methodology: The clinical simulation was carried out with 20 members, grouped in ten pairs, of the Méndez Parada Military Parachuting School at the Alcantarilla Air Base (Murcia, Spain). At an altitude of approximately 1,100 feet, each pair simulated CPR on a Little Anne® manikin fitted with a SimPad® PLUS. The results obtained were recorded by SkillReporter ™. Results: The mean duration of the procedure was approximately five minutes. During the flights, the compression depth achieved with CPR was correct in only six of the ten cases. In only one case was the “patient” checked for consciousness and respiration. In 50% of the simulations, the forehead-chin manoeuvre was not performed (i.e., the airway was not opened). Conclusions: The lack of standard recommendations in current guidelines on CPR during aircraft landing may provoke discrepancies in the management of this critical situation and reduce the quality of the treatment provided. "

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

The relationship between knowledge and self-efficacy of nurses regarding early initiation of cardiopulmonary resuscitation and automated defibrillation in Saudi Arabia.

Cardiopulmonary resuscitation (CPR) and early defibrillation are the most common procedures performed by nurses as the first responders to cardiac arrest patients in the hospital setting. Therefore, nurses are demanded to have high skills for effective performance. Self-efficacy and knowledge are considered significant factors affecting early initiation of CPR and automated defibrillation. However, previous studies mostly focused on nursing students instead of frontline nurses. This research aimed to assess the relationship between nurses' knowledge and self-efficacy regarding the early initiation of CPR and automated defibrillation of cardiac arrest patients. The study employed a cross-sectional, descriptive, correlational survey. Using convenience sampling, two hundred eighty-seven nurses working in critical areas and inpatient and outpatient departments, King Abdulaziz University Hospital (KAUH), Saudi Arabia, were selected. Resuscitation Knowledge and Self-Efficacy Scales were used for data collection (using Google Form) from November 2020 to January 2021. Descriptive statistics and Pearson correlation were used for data analysis. Overall, 61.3% of participants had moderate knowledge (13.659 ± 2.175), and 63.8% had high self-efficacy (44.627 ± 58.397). The highest domain of self-efficacy was responding and rescuing, while the lowest domain was debriefing and recording. There was a significant positive relationship between knowledge and self-efficacy (p <0.001; r = 0.207). The positive relationship explained a high level of self-efficacy if there was a high level of knowledge. Thus, it is recommended that nursing programs apply CPR and automated defibrillation curricula during nurses' internships, clear policies and procedures about CPR and automated defibrillation, continual updates about CPR and automated defibrillation, and knowledge and continuance training (on-job-training) about CPR and automated defibrillation, which can enhance and improve knowledge and self-efficacy among health care workers, especially for nurses.

Evaluation of Public Awareness, Knowledge and Attitudes about Cardiopulmonary Resuscitation: Report of İzmir.

Early initiation of cardiopulmonary resuscitation (CPR) by witnesses increases survival after cardiac arrest. In Turkey, our country, it is rare that basic life support (BLS) is initiated by a layperson. In our study, we aimed to use a survey to research awareness, level of knowledge and attitudes of the public to CPR and BLS. A 21-question survey was administered to individuals aged ≥18 years on a busy street in a city of a western region of Turkey. Topics such as knowledge about cardiac arrest findings, previous experience of CPR, knowledge of BLS and concerns related to CPR were questioned. The fully completed forms of 533 people were evaluated. There were 40.7% who stated that they had received training in CPR. For signs of cardiac arrest, 40.7% answered loss of consciousness, 49.3% answered cessation of breathing and 60.7% answered cessation of circulation. It was found that 35.5% could perform only chest compressions, 27.6% could perform mouth-to-mouth ventilation and 28.7% able to perform both. While 52.0% knew the location for performing chest compressions, 34.3% knew the correct depth and 15.6% knew the correct compression-ventilation rate. Bystander CPR was performed by 3.6%. In conclusion, 40.7% of people living in a highly educated region in the western part of Turkey had received CPR training and 3.6% performed bystander CPR. A majority of participants stated that they were willing to correct and develop their knowledge and skills related to CPR. Effective public CPR training programmes may increase the knowledge and awareness of CPR in the adult population.

Real-life time and distance covered by lay first responders alerted by means of smartphone-application: Implications for early initiation of cardiopulmonary resuscitation and access to automatic external defibrillators

Aim of the StudyTo investigate the distance covered by lay first responders (LFR) alerted for an out-of- hospital cardiac arrest (OHCA), evaluate the time elapsed between mission acceptance and arrival at the OHCA site, as well as the distance between the LFRs to the closest automatic external defibrillator (AED). MethodsThe LFR route, thus time, distance information, and the average speed of each responder were estimated. The same methodology was used to calculate the distance between the closest AED and the LFRs, as well as the distance between the AED and OHCA site. ResultsBetween June 1st, 2014 and December 31st, 2017, the LFR network was activated in occasion of 484 suspected OHCAs. 710 LFRs were automatically selected by the application and accepted the mission. On average 1.5 LFRs arrived at the OHCA site. LFRs covered a distance of 1196 m (IQR 596–2314) at a median speed of 6.9 m/s (IQR 4.5–9.8) or 24.8 Km/h. In 4.4% of the cases the speed of the LFRs was compatible with a brisk walk activity (<1.5 m/sec). The total intervention time of an LFR, who first retrieved an AED and then went to the OHCA site, was longer (275 s, IQR: 184 s–414 s) compared to the total intervention time of a LFR (197 s, IQR: 120 s–306 s; p < 0.001), who went to the OHCA site directly without retrieving an AED. ConclusionsThe dispatch of LFRs directly to the OHCA site instead of first retrieving the AED, significantly decreases the time to CPR initiation. More studies are needed to assess the prognostic implications on survival and neurological outcome.

Assessment of the levels of awareness toward cardiopulmonary resuscitation: A community-based study in Northern Saudi Arabia.

BACKGROUND:Cardiopulmonary resuscitation (CPR) is a procedure performed in an emergency when the heart stops. Early initiation of CPR can save many lives. Thus, the aim of the present study was to assess the level of awareness toward CPR in a community-based study in Northern Saudi Arabia.MATERIALS AND METHODS:This is a cross-sectional survey conducted in the city of Hail, Northern Saudi Arabia. Data about CPR were obtained from 442 Saudi volunteers living in the city of Hail.RESULTS:A family history of ischemic heart disease was indicated in 148/442 (33.5%) of the participants. On asking the participants whether they have previous information about CPR, about 258/442 (58.4%) persons indicated “Yes,” 118/442 (26.6%) replied “May be,” and the remaining 66/442 (15%) replied “No.”CONCLUSION:The study showed a high level of awareness about CPR, which might be attributed to the majority of highly educated participants. Effective and sustainable public CPR training programs are needed to be implemented to preserve better knowledge and awareness of CPR in the general population.

Exercise-Related Out-of-Hospital Cardiac Arrest Among the General Population in the Era of Public-Access Defibrillation: A Population-Based Observation in Japan.

BackgroundExercise can trigger sudden cardiac arrest. Early initiation of cardiopulmonary resuscitation and automated external defibrillator use by laypersons could maximize the survival rate following exercise‐related out‐of‐hospital cardiac arrest (OHCA).Methods and Results OHCA data between 2005 and 2012 were obtained from a prospective population‐based OHCA registry in Osaka Prefecture. Patients with OHCA of presumed cardiac origin and occurring before emergency medical service personnel arrival were included. The incidence trends of exercise‐related OHCA over the 8‐year study period were assessed. Among patients with bystander‐witnessed, exercise‐related OHCA, the trends in the initiation of bystander cardiopulmonary resuscitation, public‐access defibrillation, and outcome were evaluated. The primary outcome was 1‐month survival with favorable neurological outcome, defined as cerebral performance category 1 or 2. During the study period, 0.7% of OHCAs of cardiac origin (222/31 030) were exercise related. The incidence of exercise‐related OHCA increased from 1.8 (per million population per year) in 2005 to 4.3 in 2012. Of these, 83.8% (186/222) were witnessed by bystanders. Among the patients with bystander‐witnessed, exercise‐related OHCA, the proportion that received bystander cardiopulmonary resuscitation (50.0% in 2005 and 86.2% in 2012) and public‐access defibrillation (7.1% in 2005 and 62.1% in 2012) significantly increased during the study period. Furthermore, the rate of 1‐month survival with favorable neurological outcome among these patients significantly improved (from 28.6% in 2005 to 58.6% in 2012).ConclusionsThe incidence rate of exercise‐related OHCA was low in the study population. The increase in bystander cardiopulmonary resuscitation and public‐access defibrillation rates were associated with improved outcome among patients with bystander‐witnessed, exercise‐related OHCA.

Out of hospital cardiac arrest resuscitation outcome in North India - CARO study.

To evaluate the outcome of cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests (OHCA) in India and factors influencing the outcome. The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation (ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference. The survival rate to hospital admission was 32.5%, the survival rate to hospital discharge was 8.8% and with good cerebral performance category (CPC1) neurological status was 3.8%. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests (56.5%) with 1.3% bystander CPR rate, 92.5% arrests occurred at home, 96% presented with initial non-shockable rhythm and 92.5% with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was ≤20 minutes. Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system (EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.

Outcome of Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest Managed in Universiti Kebangsaan Malaysia Medical Centre

Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at Emergency Department (ED) increases the chance of survival from sudden cardiac arrest. The main objective of this study was to identify the factors that influenced the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The second objective was to determine the incidence of CPR initiated by the public prior to ambulance arrival. The present study was a one-year cross-sectional study. The OHCA patients were identified from the ED resuscitation logbook. Patients’ medical records were used to obtain details of the resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene CPR, use of automated external defibrillators (AEDs), mode of transportation and the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical data was analysed using chi-square and Fisher exact tests. Nine patients out of 98 had early CPR. Three patients achieved ROSC. Gender was significantly associated with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC compared to those who received late CPR. The provision of early CPR and usage of AEDs by the public is still low. Female gender had a positive influence on ROSC. Efforts are required to increase the awareness and involvement of the public in initiating early CPR prior to the arrival of ambulance service.

Therapeutic Hypothermia and Out-of-Hospital Cardiac Arrest in a Child with Hypertrophic Obstructive Cardiomyopathy.

Neurologic outcomes following pediatric cardiac arrest are consistently poor. Early initiation of cardiopulmonary resuscitation has been shown to have positive effects on both survival to hospital discharge, and improved neurological outcomes after cardiac arrest. Additionally, the use of therapeutic hypothermia may improve survival in pediatric cardiac arrest patients admitted to the intensive care unit. We report a child with congenital hypertrophic obstructive cardiomyopathy and an out-of-hospital cardiac arrest, in whom the early initiation of effective prolonged cardiopulmonary resuscitation and subsequent administration of therapeutic hypothermia contributed to a positive outcome with no gross neurologic sequelae. Continuing efforts should be made to promote and employ high-quality cardiopulmonary resuscitation, which likely contributed to the positive outcome of this case. Further research will be necessary to develop and solidify national guidelines for the implementation of therapeutic hypothermia in selected subpopulations of children with OHCA.

Abstract 325: Differences in the Implications of the Time Interval from Collapse to Initiation of Cardiopulmonary Resuscitation and to Return of Spontaneous Circulation for the Prognosis of Out-of-Hospital Cardiac Arrest Patients

Introduction : Out-of-hospital cardiac arrest patients have a poor prognosis even if cardiopulmonary resuscitation (CPR) is administered. The time interval from collapse to initiation of CPR (CA-CPR) and the time interval from collapse to return of spontaneous circulation (CA-ROSC) are reported to be predictors of survival in cardiac arrest patients. However, the clinical implications of both durations remain unclear. Hypothesis : We assessed the hypothesis that CA-CPR and CA-ROSC have different impacts on the prognosis of out-of-hospital cardiac arrest patients. Methods : We enrolled adult out-of-hospital cardiac arrest patients between 2006 and 2010 in this study. Receiver-operating characteristic curves of CA-CPR and CA-ROSC were generated to analyse favourable neurological outcomes. We assessed the independent predictors of return of spontaneous circulation (ROSC) and favourable neurological outcomes by using the logistic regression model. A P value of &lt; 0.05 was considered statistically significant. Results : We enrolled 1194 patients. The median age was 74 y (interquartile range 61-83 y); 61% were males. Fifty-two percent of the patients involved witnessed cardiac arrest; 76% of the patients were received by-stander CPR, 11% of the patients whose initial recorded rhythm was shockable rhythm. The CA-CPR for patients who achieved ROSC (n = 422) was shorter than that for patients who did not achieved ROSC (7 min (1-14 min) vs. 19 min (8-51 min), P &lt; 0.001). From the patients who achieved ROSC, the patients who had favourable neurological outcomes had shorter CA-CPR (2 min (1-7 min) vs. 8 min (2-15 min), P &lt; 0.001) and CA-ROSC (13 min (9-22 min) vs. 46 min (34-58 min), P &lt; 0.001). The area under the curve for the CA-CPR predicting ROSC was 0.74. The area under the curve for the CA-CPR and the CA-ROSC predicting favourable neurological outcomes in patients who achieved ROSC was 0.69 and 0.89, respectively. Multivariable analysis showed that the CA-CPR was associated with ROSC and CA-ROSC but not A-CPR was associated with favourable neurological outcomes. Conclusions : Early initiation of CPR is associated with ROSC, and early ROSC in turn is associated with favourable neurological outcomes in out-of-hospital cardiac arrest patients.

Where would you like your cardiac arrest: In public or at home?Status: PendingCategory: CPR Quality

Purpose of the study: Survival after cardiac arrest is correlated to early initiation of cardiopulmonary resuscitation (CPR)1–3. The aim of this study was to detect differences between arrest which occur in public or at home regarding presence of bystander CPR and outcome.

Exercise related cardiac arrest in amateur athletes on the tennis court

Aim of the study The aim of this study was to study exercise-related cardiac arrests on the tennis court and investigate the impact of early initiation of cardiopulmonary resuscitation on survival rate and outcome. Methods This study was based on the cardiac arrest registry of the Department of Emergency Medicine at the General Hospital Vienna in Austria. Between February 1993 and April 2010 non-professional athletes were identified, who experienced exercise-related cardiac arrest on the tennis court. The analysis was accomplished using descriptive statistics. Results are presented as mean ± standard-deviation or median and interquartile range (IQR). Results The subjects ( n = 27) were predominantly male (96%) with a median age of 58 years; 52% of all patients had underlying cardiovascular risk factors. All cardiac arrests were witnessed. Bystander CPR was documented in 17 cases (63%). Median time from collapse to initiation of CPR was 1(IQR 0–2) minute. Ventricular fibrillation was the initial rhythm in 25 patients (93%) and in 3 an automated external defibrillator was used by bystanders. Twenty-four patients (89%) had return of spontaneous circulation before admission to the hospital and four (15%) followed verbal commands thereafter. The survival rate at 6 months was 82% with 20 patients (74%) having favourable neurologic outcome. Conclusions Cardiac arrest on the tennis court is a predominantly witnessed event with a respectively high rate of bystander CPR, which reflects in a high successful survival rate.

Anesthesia Literature Review

Anesthesia Literature Review

Cardiac arrest in amateur athletes on the tennis court

Purpose of the study: Unlike the majority of out-of-hospital arrests, cardiac arrests on the tennis court are predominantly witnessed. The aim of this study was to study exercise-related cardiac arrests on the tennis court and investigate the impact of early initiation of cardiopulmonary resuscitation (CPR) on survival rate and outcome.

Assessment of the success of cardiopulmonary resuscitation attempts performed in a Turkish university hospital

The success rate of cardiopulmonary resuscitation (CPR) may differ from institution to institution, even within different sites in the same institution. A variety of factors may influence the outcome. In this study, we assessed the adequacy of CPR attempts guided by the current standards and aimed to define the factors influencing the outcome following in-hospital cardiac arrest. One hundred and thirty-four patients who required CPR were studied prospectively. Different variables for the CPR performance were recorded using forms designed for this study in the light of the guidelines. In these CPR forms various data including the demographics, history, monitoring, number, composition and experience of the anaesthesiologists, the site of CPR, time of day, the delay before onset of CPR, tracheal intubation, duration of arrest, initial rhythm in ECG monitored patients, management of CPR, drug administration and reversible causes of cardiac arrest were recorded. Our rates of immediate survival, survival at 24 h and survival to discharge 49.3%, 28.5% and 13.4%, respectively. The extent of monitoring prior to arrest, the attendance of one or more experienced anesthesiologists in the CPR team, CPR during office hours, CPR in ICU or operating room, early initiation of CPR and tracheal intubation prior to arrest were found as the factors increasing discharge survival. We conclude that early initiation of CPR with an experienced team in a well-equipped hospital sites increases the discharge survival rate following cardiac arrest.

Comparison of Nifekalant and Lidocaine for the Treatment of Shock-Refractory Ventricular Fibrillation

Although nifekalant is a class III antiarrhythmic agent without negative inotropic activity, its effect in patients with shock-refractory ventricular fibrillation remains unclear. Patients who had an out-of-hospital cardiac arrest with ventricular fibrillation that persisted after 3 shocks from an external defibrillator, intravenous epinephrine, and another shock were retrospectively studied. The patients received lidocaine from January 1997 through June 2001 and nifekalant from July 2001 through December 2004. Short-term survival rates (survival to hospital admission and 24-h survival) were compared between the groups. The study group comprised 120 patients (mean age: 62+/-16 years): 55 received nifekalant and 65 received lidocaine. Age, sex, history of ischemic heart disease, whether arrest was witnessed or not and time to arrival at the hospital did not differ significantly between the groups. As compared with lidocaine, nifekalant was associated with significantly higher rates of survival to hospital admission (67% vs 37%, p<0.001) and 24-h survival (53% vs 31%, p=0.01). Multivariate analysis showed that treatment with nifekalant and early initiation of cardiopulmonary resuscitation were independent predictors of 24-h survival. As compared with lidocaine, nifekalant may improve short-term survival in patients with out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation.

Improved Survival from Cardiac Arrest in the Community

We now know that the elements required to achieve the highest survival rates from out-of-hospital cardiac arrest include: witnessed arrest, rapid telephone notification of the emergency medical service, early initiation of cardiopulmonary resuscitation, rapid arrival within minutes of emergency personnel equipped with a defibrillator, and early advanced airway management and intravenous pharmacology. In the United States, and in several other countries innovative approaches have been tried to bring all these elements together in one system. These approaches include community-wide CPR training programs, telephone-assisted CPR instruction delivered at the time of a cardiac arrest, early defibrillation performed by family members of high risk patients, early defibrillation performed by minimally trained community responders, and early defibrillation performed by minimally trained ambulance personnel. Controlled, prospective studies have demonstrated the effectiveness and practicality of all of these approaches. New studies are in progress with the prehospital use of early transcutaneous cardiac pacing and these show promise. This article reviews the evidence that supports these multi-layered and innovative approaches to the treatment of out-of-hospital cardiac arrest.

Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation

Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better ( P < 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P < 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4–6 minutes from the time of collapse and must be followed within 10–12 minutes of the collapse by advanced life support in order to be effective.